Chemotherapy toxicity

Chemotherapy toxicity - #37

Crucial Questions: Three questions to ask when assessing an elderly patient with cancer include:
1. Will this patient die from this cancer or with this cancer?
2. Is this patient at risk for complications from this cancer?
3. Is this patient able to tolerate cancer treatment?

Prior to initiation of chemotherapy, an extensive evaluation is required to assess appropriateness of treatment for that individual patient. While there is not an absolute age-determined cutoff for receiving chemotherapy, physical, cognitive, functional and social factors help determine a geriatric patient's ability to tolerate chemotherapy.

Chemotherapy Toxicity:
The most common scale for assessing toxicity from chemotherapy was developed by ECOG and graded from 0-5 with 0 being no change from baseline and 5 being death from toxicity.

Cancer is a significant source of morbidity and mortality for the elderly, with 53% of new cancers being diagnosed in those greater than 65 years old. The risk of developing cancer increases in men from 1 in 6 men (between ages 60-69) to 1 in 3 men (after age 70 years); for women the risk increases from 1 in 10 to 1 in 4 for the same age distributions. Data regarding the toxic effects of chemotherapy in geriatric patients is often limited due to frequent exclusion from clinical trials. A Cancer and Aging Research Group study that evaluated 500 patients >65 years (mean 73 years) with stage I to IV cancer showed 1 or more grade 3-5 toxicity occurrence in 53% of patients. The International Society of Geriatric Oncology Taskforce performed a review in 2007 of chemotherapy for elderly patients. The common toxicities associated with various chemotherapy regimens are found in Table 1.

Normal physiologic changes with aging may increase the likelihood of chemotherapy side effects and toxicity in older adults. Elderly patients are often under-represented in cancer clinical trials and thus evidence regarding toxicities is retrospective and anecdotal.

Disclaimer: Geriatric Fast Facts are for informational, educational and research purposes only. Geriatric Fast Facts are not, nor are they intended to be, medical advice. Health care providers should exercise their own independent clinical judgment when diagnosing and treating patients. Some Geriatric Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Terms of Use: Geriatric Fast Facts are provided for informational, educational and research purposes only. Use of the material for any other purpose constitutes infringement of the copyright and intellectual property rights owned by the specific authors and/or their affiliated institutions listed on each Fast Fact. By using any of this material, you assume all risks of copyright infringement and related liability. Geriatric Fast Facts may not be reproduced or used for unauthorized purposes without prior written permission, which may be obtained by submitting a written request to: Medical College of Wisconsin, Dept. of Medicine, Division of Geriatrics and Gerontology, 8701 Watertown Plank Road, Milwaukee, WI 53226. Note the Geriatric Fast Facts may contain copyrighted work created under contract with government agencies, foundations, funding organizations and commercial companies, etc. If a particular author places further restrictions on the material, you must honor those restrictions regardless of whether such restrictions are described in this mobile app.